Healthcare Provider Details

I. General information

NPI: 1841417847
Provider Name (Legal Business Name): FARLEY CHUI HOM LAC, OTRL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 S SEPULVEDA BLVD SIUTE 205
LOS ANGELES CA
90064-0002
US

IV. Provider business mailing address

3715 JASMINE AVE APT 7
LOS ANGELES CA
90034-5954
US

V. Phone/Fax

Practice location:
  • Phone: 310-561-5657
  • Fax:
Mailing address:
  • Phone: 310-561-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10759
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: